If you’re approaching the conclusion of your lawsuit, you have probably heard you might need to set up a Medicare set-aside (MSA) to protect your Medicare benefits. An MSA is an amount of money you, your attorney, and a settlement planning expert determines will show a good-faith effort to fund your future care without relying solely on Medicare.
When is a Medicare Set-Aside NOT Necessary?
If a client is Medicare-eligible but no amount of the settlement was intended for future medical care — for example, if the settlement only covers past damages and wages — an MSA is most likely not recommended.
On the other hand, Medicare can deny payment on surgery and other medical care if some part of the settlement was meant to cover the future surgery and no effort was made to adequately consider Medicare’s interests. Having a financial expert review an your Medicare compliance approach ahead of settlement avoids that pitfall — when the time comes that you need surgery or other care in the future.
How Much Money Should Be in My MSA?
Knowing the appropriate amount of money to set aside in your MSA is critical for adequately complying with Medicare. Four factors help determine what’s appropriate:
- The full amount of your settlement;
- If you went to trial or arbitration, the full value of your case;
- The amount recovered from your case that is allocated to future medical expenses;
- How much Medicare-allowable medical treatment you’ll need over your lifetime.
The process of determining how much money should be in an MSA is all about numbers. Medicare also references this table to help determine a person’s life expectancy, which impacts how much he or she should put aside.
The most difficult part of the settlement and financial planning process is trusting someone early on to explain what’s going on and how you need to move forward. Just like having a strategic financial plan, it’s important to know what you or your loved ones out of pocket costs for medical care will be for the rest of their life. You should know what this amount is before you agree to settle. Giving families the confidence to settle is what we do. No matter where in the U.S. you live, please feel free to call for a free consultation on how to set up an MSA or to evaluate whether you need one.
Contact Author John Bair for Settlement Planning Help
If you’re considering establishing an MSA with some of your case recovery, you likely have more questions. John Bair has guided thousands of plaintiffs through the settlement process as co-founder of Milestone Consulting, LLC, a broad-based settlement planning and management firm. Milestone’s approach is comprehensive and future-focused. John’s team has guided thousands of clients by taking the time to understand the complexities of each case. They assess the best outcome and find the path that enables each client to manage their many needs. Read more about Milestone Consulting at http://milestoneseventh.com/.
A West Point graduate where he served as captain and military aviator, John Bair continues his commitment to our country through his efforts within the settlement planning industry. He has represented families of victims lost in the Flight 3407 crash, offered pro bono services to the families of 9/11 victims and drafted the first consumer protection bill for plaintiffs (H.R. 3699).